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Southern diet may raise risk for CHD
A dietary pattern similar to that consumed in the southern United States was associated with increased risk for CHD, according to new findings from the REGARDS study.
Researchers analyzed 17,418 white and black adults aged 45 years or older without known CHD at baseline who were enrolled in the REGARDS study from 2003 to 2007.
Five dietary patterns were observed: convenience; plant-based; sweets; Southern; and alcohol and salad. They defined the Southern diet as one with high levels of added fats, fried food, eggs, organ and processed meats and sugar-sweetened drinks. The researchers stratified participants by quartiles in each dietary pattern and analyzed the risk for nonfatal MI or acute CHD death associated with consumption of each pattern. Median follow-up was 5.8 years.
Diet and CHD risk
After adjustment for sociodemographics, lifestyle factors and energy intake, those in the highest quartile of Southern dietary pattern consumption were at elevated risk for CHD compared with those in the lowest quartile (HR = 1.56; 95% CI, 1.17-2.08; P for trend = .003). When the researchers added anthropometric and medical history variables to the analysis, the association remained, but was not as strong (HR = 1.37; 95% CI, 1.01-1.85).
The other four dietary patterns were not associated with increased risk for CHD after adjustments.
James M. Shikany
“Regardless of your gender, race or where you live, if you frequently eat a Southern-style diet, you should be aware of your risk of heart disease and try to make some gradual changes to your diet,” James M. Shikany, DrPH, from the division of preventive medicine of the school of medicine at the University of Alabama at Birmingham, said in a press release. “Try cutting down on the number of times you eat fried foods or processed meats from every day to 3 days a week as a start, and try substituting baked or grilled chicken or vegetable-based foods.”
According to the researchers, those in the highest quartile of Southern diet consumption were more likely to be aged younger than 65 years, black, not have a high school diploma, have an annual household income of less than $20,000 and reside within the “stroke belt.” Compared with low consumption of the Southern pattern, those with high consumption were more likely to smoke; have dyslipidemia, hypertension, diabetes; and have a higher BMI and waist circumference.
Additional insights needed
In a related editorial, Susan M. Krebs-Smith, PhD, MPH, and colleagues noted that the researchers “did indeed identify distinct factors which explain the variability of food intakes into this sample, and one of those factors was related to CHD in this sample.”
However, Krebs-Smith, from the epidemiology and genomics research program of the National Cancer Institute, Bethesda, Maryland, and colleagues wrote, “Questions remain regarding how those factors relate to the overall pattern of eating, whether those factors could be identified in other samples, and whether those factors are the most important with regard to CHD. If this study was re-examined with different methods, we would have additional insights regarding the relationship between diet and CHD in this population.” – by Erik Swain
Disclosures: The researchers and editorial writers report no relevant financial disclosures.
Perspective
Back to TopThe REGARDS trial provides us with additional insight related to CHD risk and health disparities. Despite being an observational study, the findings solidify and add to an ever-growing body of knowledge that is all too well known to health care providers and researchers: Increased risk in the “Stroke Belt” appears to be the result of clustering of risk factors that are major contributors to the development of CVD. This study further identifies dietary patterns that confer CV risk. The Southern dietary pattern characterized as a diet consisting heavily of added fats, eggs, fried foods, organ meats and sugar-sweetened beverages appears to convey the greatest risk. Those studied who consumed the Southern diet were also noted to have higher rates of smoking, dyslipidemia, hypertension, diabetes, increased BMI and larger waist circumferences. This clustering of risks translates into an excessive risk of CHD. A recent CDC analysis concluded that only 13.1% of American adults consume enough fruits and only 8.9% eat enough vegetables. The benefits of fruit and vegetable consumption are well known and aid in the reduction of heart disease, stroke and some cancers. The social and economic determinants of health inequities are magnified in the South and significantly contribute to this excess burden of disease. The participants in the study who were most likely to consume the Southern diet pattern were also more prominently represented by African Americans, lower socioeconomic income status and possessed a higher prevalence of the traditional risk factors.
Confronting these complex, multidimensional issues requires a multipronged approach that includes public education, addressing inadequate school nutrition programs, a lack of physical activity in schools, urban neighborhood planning, creating safe living environments and economic empowerment. These are all formidable tasks. However, if we are truly committed to transforming health, addressing these targets are essential. Populations residing in food deserts, neighborhoods riddled with crime, inadequate public education, and lacking in economic opportunity create an insurmountable barrier to reducing health inequities. Addressing the eating habits of the “comfort foods” of the south will deepen our understanding of the determinants of health. However, the larger societal issues remain our most formidable challenge.